Implementation of Pulse Inversion Harmonic Imaging
on 2d Convex Transducer on Anatomical Information of first-trimester Pregnancy Ultrasound
Image
Diah
Rusita1*, Donny Kristanto Mulyantoro2,
Agung Nugroho Setiawan3
Poltekkes Kemenkes Semarang, Semarang, Central Java, Indonesia 1,2,3
Email:
diah.rusita.indarto@gmail.com
|
KEYWORDS |
ABSTRACT |
|
Pulse Inversion, Harmonic Imaging, Convex Transducer,
Anatomical Information, Pregnancy, Ultrasound Image. |
This study aims to compare the imaging results of
Pulse Inversion Harmonic Imaging (PIHI) on transabdominal ultrasound with
convex 2D transducer with and without PIHI on transvaginal ultrasound in
providing anatomical information on first-trimester pregnancies. Involving 30
pregnant women meeting inclusion and exclusion criteria, the research was
conducted at Swamedika Clinic Jakarta in August 2023. A quasi-experimental
method was employed with evaluation performed by ultrasound experts and
assessment by a radiologist unaware of PIHI use. The findings indicate that
the use of PIHI on transabdominal ultrasound yields clear images of the
boundary walls, fetal objects, and yolk sac boundary with appropriate
frequency, gain, and depth settings. However, the comparative analysis
between images with PIHI on transabdominal and without PIHI on transvaginal
did not show significant differences. This study highlights the potential of
PIHI in enhancing the quality of ultrasound images in the first trimester of
pregnancy, although the results did not significantly differ from
transvaginal technique without PIHI. |
|
DOI:
10.58860/ijsh.v3i3.184 |
|
Corresponding Author: Diah Rusita*
Email: diah.rusita.indarto@gmail.com
INTRODUCTION
The health of the fetus and mother in the first trimester
of pregnancy is crucial, considering that time is the beginning of fetal life development. Nutrition and health provided by
the mother must be considered, and maintaining a diet and exercising as
recommended by a doctor will facilitate the course of labour in the future (1).
In terms of health, it also needs to be considered not only from the outside
but can be added with an ultrasound examination that can clearly describe the
shape, location and size of the fetus because it is expected that the pregnancy
will run normally (2). The use of first-trimester ultrasound has benefits for
determining age, ensuring the fetus lives in good
condition and congenital abnormalities in early fetal
development (3).
Ultrasound
in the first trimester generally uses a transvaginal transducer because
high-quality images are obtained from the position of the intrauterine
transducer closer to the uterus and gestational sac than abdominal ultrasound. Transvaginal
ultrasound in the first trimester of pregnancy examination is done with
preparation. Namely, the patient is asked to urinate before the examination so
that there are no artefacts from urine. Transvaginal ultrasound has the
disadvantage that discomfort is given during the examination by inserting a transvaginal
transducer into the vagina, before examination the surface of the transducer is
given a gel; then the transducer is coated with a condom to see the gestational
sac, yolk sac and fetal position. The existence of transvaginal
probes is also very limited in the field due to the limited number of users who
can use them and the need to purchase additional probes (4).
Transabdominal
ultrasound in pregnant patients does not need to be inserted transducer, which
can stress the patient, and does not require special attention to be coated
with additional gel condoms;nal gel condoms, the convex
2D transducer is the main package that is included in the budget purchase
package of ultrasound equipment. There are convex transducers that are 4D and
2D, for 4D transducers can be used for
2D as well. Because the frequency of the 4D probe is higher, the resolution of
the 2D convex transducer is smoother than the 2D resolution in the 2D convex
transducer, therefore utilizing Pulse Inversion Harmonic Imaging can help
refine the resolution of the 2D convex transducer (5).
Transabdominal
ultrasound in the first trimester of pregnancy examination is done with
preparation. Namely, the patient is expected to drink a glass of water one hour
before the examination and hold urination as acoustic shadow (6). When applied
evenly in the abdominal area, the function of the gel is to reduce acoustic
impedance from the surrounding air; an ultrasound is performed to see the
gestational sac, yolk sac, and fetal position (7)
(8).
Pregnancy
examination in the first trimester can be done with a 2D convex transducer by
adjusting the parameters of ultrasound images to maximize image results,
including adjusting frequency, gain, depth and Pulse Inversion Harmonic Imaging
(9).
The
application of Pulse Inversion Harmonic Imaging limits the linear echo provided
by Conventional Ultrasound and Tissue Harmonic Imaging so that the image
obtained is much smoother and more detailed (10). So, its use is very
beneficial for the use of transabdominal ultrasound in terms of comfort and a
good image that can improve the first-trimester pregnancy examination and make
patients comfortable.
In
ultrasound, frequency, gain, and depth are used in ultrasound imaging because
the setting can increase the resolution of the ultrasound image which is
affected by the weight of the object under study. Therefore, this study is
limited to objects with normal weight. Pulse Inversion Harmonic Imaging
parameters, Frequency 2 MHz, Depth 8 cm and Gain 55 on 2D convex transducers. Pulse Inversion
Harmonic Imaging parameters, Frequency 5 MHz, Depth 5 cm and Gain 48 on transducer
transducers. This parameter number is set and determined when researchers
implement it on sample objects with normal body weight to get good image image results.
METHOD
This study used a quasi-experimental method
to compare the results of Pulse Inversion Harmonic Imaging (PIHI) images on 2D
transabdominal transducer convex ultrasound with and without PIHI on
transvaginal ultrasound. The object of study is anatomical information of the
first-trimester pregnancy ultrasound image, which includes gestational sac, fetus, and yolk sac images. Data were obtained from 30
pregnant women with normal weights and pregnancies, selected through purposive
sampling techniques. Inclusion and exclusion criteria have been established to
select samples suitable for the study's purpose. The study was conducted at Swamedika Clinic Jakarta in August 2023.
The research procedure involved evaluating
first-trimester pregnancies using two different ultrasound techniques, namely
transabdominal with PIHI on a 2D convex transducer and transvaginal. An
ultrasound expert carries out the examination with certain settings on the
ultrasound device. Ultrasound results are evaluated by radiologists who are not
aware of the use of PIHI. Assessment is carried out by questionnaires that
measure the clarity of the picture ordinally.
The data processing method involves
univariate analysis to describe the variables studied and bivariate analysis to
compare the results of the picture between the two ultrasound techniques.
Bivariate analysis used the Mann-Whitney statistical test to determine
significant differences between the two groups.
The tools and materials used in data
processing include ultrasound tools, transducers, and examination support
materials such as ultrasound gel. Special preparations are made for
transvaginal and transabdominal examinations. Arrangements on ultrasound
devices include the use of PIHI in the transabdominal and without PIHI in the
transvaginal. After that, the data was analyzed to
see the difference in the picture results between the two ultrasound
techniques.
This study aims to determine whether the use
of PIHI in the transabdominal can provide better anatomical information of
first-trimester pregnancy ultrasound images compared to techniques without PIHI
in the transvaginal.
RESULTS AND DISCUSSION
Image Results Characteristics
The
research data collection was carried out in August 2023 at the BNI Jakarta Swamedica Clinic. The patient is a pregnant woman with a
normal weight during the first trimester of pregnancy.
Then
the first-trimester pregnancy ultrasound examination was carried out, with the
results of anatomical information of the first-trimester pregnancy ultrasound
image, namely gestational sac, fetus, and yolk sac, by
applying the Pulse Inversion Harmonic Imaging upgrade method on the 2D convex and without Pulse Inversion Harmonic
Imaging on transvaginal.
A
study was conducted with 30 patients, as many as 30 women, with the number of
research objects, namely anatomical information of first-trimester pregnancy
ultrasound images in the gestational sac, fetus and yolk
sac using Pulse Inversion Harmonic Imaging upgrade on 2D convex as many as 30
images and without Pulse Inversion Harmonic Imaging on transvaginal ultrasound as
many as 30 images.
Table 1. Questionnaire Results from 1 Radiology Doctor.
|
Score |
Information |
Pulse Inversion Harmonic Imaging
upgrade with convex 2D |
No Pulse
Inversion Harmonic Imaging with 2D
transvaginal |
|
1 |
Unclear |
0% |
0% |
|
2 |
Clear |
30% |
23,33% |
|
3 |
Very
clear |
70% |
76,67% |
Based
on table 1. which is the questionnaire data obtained from 1 Radiology
Doctor in conditions using Pulse Inversion Harmonic Imaging upgrade on the 2D convex
which has a score of 1 as much as 0 which is 0%, score of 2 as much as 9 which
is 30% and score 3 as much as 21 which is 70%. Without Pulse Inversion Harmonic
Imaging in transvaginal which has a score of 1, as much as 0 which is 0%, a
score of 2, as much as 7, which is 23.33%; and a score of 3, as much as 23,
which is 76.67, %.
Picture 1. Pulse
Inversion Harmonic Imaging Upgrade on Convex 2D
with Frequency 2 MHz, Depth 8 cm and Gain 55.
Figure 2. No Pulse Inversion
Harmonic Imaging in transvaginal with Frequency 5 MHz, Depth 5 cm and Gain
48.
Descriptive Test
Table 2. Descriptive Test Table.
|
Pulse Inversion Harmonic Upgrade with convex 2D |
Mean |
2.7 |
|
|
Median |
3 |
|
|
Std.
Deviation |
0.46609 |
|
|
Minimum |
2 |
|
|
Maximum |
3 |
|
|
Std
Error |
0,0851 |
|
Without Pulse Inversion Harmonic with Transvaginal |
Mean |
2.7667 |
|
|
Median |
3 |
|
|
Std.
Deviation |
0.43018 |
|
|
Minimum |
2 |
|
|
Maximum |
3 |
|
|
Std
Error |
0,07854 |
In this data analysis, we compared two groups
of measurements, namely "Pulse Inversion Harmonic Upgrade with convex 2D" and "Without
Pulse Inversion Harmonic with transvaginal".
For the first group, the average measurement was 2.7, with most of the data
centered around a value of 3, as indicated by a median that was also 3.
However, a relatively high standard deviation of 0.46609 indicates a
significant variation from the mean.
On the other hand, the
second group, "Without Pulse Inversion Harmonic with transvaginal", had a slightly
higher average measurement of 2.7667. A median returning 3 indicates a
symmetrical distribution of data, and a slightly lower standard deviation,
which is 0.43018, indicates a smaller variation in measurements.
Although there are small
differences between the averages of the two groups, these differences may not
be clinically significant. Meanwhile, a larger standard deviation in the first
group showed greater variation in measurements. In conclusion, both groups had
similar data distributions, but further attention may be needed regarding
variations within the first group.
In the context of this study, these results
should be viewed taking into account measurement methodology and design.
Further interpretation may be needed to explore the clinical implications of
the observed differences.
Table 3. Whitney Mann Test Table
|
Method |
N |
Mean Rank |
Sum of Ranks |
|
|
Test Results |
Pulse Inversion
Harmonic Upgrade with convex 2D |
30 |
29.5 |
885 |
|
|
Without Pulse
Inversion Harmonic with Transvaginal |
30 |
31.5 |
945 |
|
|
Total |
60 |
|
|
Table
4. Test Statistics
|
Test Statistics |
Test Results |
|
Mann-Whitney U |
420 |
|
a Grouping Variable: Method |
|
|
Test Results |
Mann-Whitney U |
|
Hypothesis |
H0:
There was no median difference between the two groups |
|
U value |
420 |
|
Alpha |
0.05 |
|
Conclusion |
Insignificant |
Table
5. Test Results
In conducting a comparative analysis between
the two groups, "Pulse Inversion" and "Without Pulse
Inversion," the Mann-Whitney test is involved as the primary statistical
tool for assessing median differences. The null (H0) hypothesis proposed is
that the two groups have no significant median difference. The Mann-Whitney U
Statistic, with a score of 420, shows a comparison of rankings between the two
groups.
These
results provide an in-depth understanding of the characteristics of the
variable distribution measured in the context of the methods "Pulse
Inversion" and "Without Pulse Inversion." Although ranking
differences were found, statistical values did not support a significant median
difference between the two groups. This interpretation is important in the
context of further research regarding the influence of the method used on the
observed variables. Thus, these findings can make a meaningful contribution to
scientific understanding in related fields and become the basis for further
development of knowledge.
Analysis Based on Statistical Test Data
Statistical analysis data is processed based
on questionnaire data filled out by 1 expert, namely a radiology specialist.
The next stage of data processing is using SPSS statistical software, where the
first stage of data processing will be carried out using the descriptive test
(Appendix 10) and the Mann-Whitney test (Appendix 11). The data compared
consisted of two groups of measurements, namely "Pulse Inversion Harmonic
Upgrade with convex 2D" as the first group and "Without Pulse
Inversion Harmonic with transvaginal" as the second group in first
trimester pregnant women with normal weight and normal pregnancy.
In the Descriptive Test
data analysis, the conclusion of the descriptive test, both groups have a
similar distribution of data, but further attention may be needed regarding
variations within the first group.
In data analysis, the Mann-Whitney Test is
the main statistical tool for assessing median differences. Although ranking
differences were found, statistical values did not support a significant median
difference between the two groups.
Analysis of Anatomical Information of First
Trimester Pregnancy Ultrasound Image with implementation of Pulse Inversion
Hamonic Imaging Upgrade on 2D Convex Transducer and Without Pulse Inversion
Harmonic Imaging on Transvaginal Transducer.
In
the results of this research discussion, the results of first-trimester
pregnancy ultrasound images have been applied with the implementation of Pulse
Inversion Harmonic Imaging upgrade on a 2D convex transducer and without Pulse
Inversion Harmonic Imaging on the transvaginal transducer.
Pregnancy
examination in the first trimester can be done with transducer convex 2D
ultrasound image parameters using Pulse Inversion Harmonic Imaging and maximize
image results, including frequency, gain and depth parameters. In ultrasound, Pulse
Inversion Harmonic Imaging is used in ultrasound imaging because it has better
spatial resolution and contrast as well as fewer artefacts than conventional
ultrasound (CUS) and makes it easier for patients who are difficulty doing
ultrasound examination because it uses pure harmonic signals and is known to
provide good spatial resolution.
From the results of the analysis, there was no
significant difference in imaging results between the groups "Without
Pulse Inversion Harmonic with transvaginal" and "Pulse Inversion
Harmonic upgrade with convex 2D" against the implementation of Pulse
Inversion Imaging upgrade on transducer convex 2D anatomical information of
first trimester pregnancy ultrasound images. So that the image of the 2D
convex probe with Pulse Inversion Harmonic Imaging upgrade is clear on the wall
barrier, clearly visible on fetal objects, and clearly visible on the yolk sac
wall barrier.
The implementation of Pulse Inversion
Harmonic Imaging on 2D convex transducers for gestational ultrasound imaging,
specifically targeting anatomical details of the sac, fetus,
and yolk sac during the first trimester, has undergone investigation. It is
evident that employing Pulse Inversion Harmonic Imaging with appropriate
frequency, gain, and depth settings enhances the visibility of images obtained
through 2D convex transducers. The upgrade significantly improves the clarity
of images, particularly highlighting details such as the wall barrier, fetal objects, and the yolk sac wall barrier. Comparative
analysis between images captured with the upgraded Pulse Inversion Harmonic
Imaging on 2D convex transducers and those obtained using transvaginal
transducers without such enhancement reveals no significant disparities.
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